Hold Back The Herbals

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Pat Woodley's approach to managing her health took an abrupt turn after she visited a naturopath about six years ago. Wracked by arthritis, she wasn't happy with the idea of taking a prescription drug for a long stretch. The naturopath devised for her a new regime, which includes what Woodley calls a "tonic" and fish oil. He also suggested she take a calcium supplement to strengthen her bones and vitamin E for better circulation. Observing advice she heard in a public speech by celebrity doctor Sandra Cabot - whose books include Raw Juices Can Save Your Life - Woodley, 63, takes her medicines not all at once but over the course of the day. And are they working? "I think they help," she says. "My joints have been a little less stiff, though they do flare sometimes in humid weather."

The temporary shutdown of Pan Pharmaceuticals, Australia's biggest contract manufacturer of vitamins, minerals and alternative medicines, has many people worried. Users of the company's products will be upset - even distraught - if they can't buy their favorite medicines in coming weeks. But many doctors insist that the human cost of Pan's troubles won't include those essentially healthy Australians who collectively spend $A500 million a year on vitamin and mineral supplements. "I'm quite convinced that they don't do a jot of good," says Sydney general practitioner Paul Koenig.

Sure to be affected, however, are thousands who earn their living in the industry. Suspended from business for six months and accused by the industry's watchdog, the Therapeutic Goods Administration, of shoddily preparing its supplements and manipulating test results, Pan may have to retrench some of its 220 employees, while small health-food shops in Australia and New Zealand - their shelves stripped almost bare by the recall of more than 1,300 products - may go to the wall.

Outside of the TGA, it seems no one saw the Pan crisis coming. The company's four directors had assumed an April 28 meeting called by the TGA would involve a routine discussion about an audit completed two weeks earlier. "You could have knocked me over with a feather when they gave us the notice to cease production," said Pan director Colin Henson.

The TGA had started homing in on Pan several months earlier, when 19 users of travel sickness pills, manufactured by Pan for another company, were hospitalized after experiencing adverse reactions including hallucinations. One wanted to jump out of a plane. Testing revealed that an anti-nausea agent was missing from some tablets and present at up to seven times the listed concentration in others. After recalling Travacalm in January, the TGA began a wider investigation of Pan, which exports to 40 countries. With the watchdog recalling hundreds more products each day and suggesting that the company might lose its licence permanently unless there were changes at the top, Pan's founder and chief executive, Jim Selim, resigned on May 1. A friend was quoted as saying that Selim was "very depressed" and had "locked himself away."

The health supplements aisle of most supermarkets is a colorful place, packed with vitamins, minerals and products that would have pricked the ears of Macbeth's witches (freeze-dried liver concentrate, shark cartilage). They promise all sorts of desirable results (brighter eyes, improved memory, heightened libido). Proponents point to studies suggesting that certain supplements can be helpful in treating specific ailments. Doses of the vitamins B12 and folic acid, for example, appear to help sufferers of heart disease by preventing further narrowing of the coronary arteries; a supplement of antioxidants plus zinc may slow the progress of age-related eye disease.

But the weight of evidence suggests that for healthy people, nutritional supplements are nearly always a waste of money, useless not only for staving off the big killers - cancer, heart attacks and stroke - but for preventing or shortening the course of minor maladies such as colds. GP Koenig says it's "once in a blue moon" that he'll prescribe vitamins to a patient. Half the world's population survives on rice and the odd vegetable, he tells mothers worried about their child's diet. In a wealthy country like Australia, he says, only someone with an extraordinarily bad diet would be vitamin deficient. And because the kidneys quickly rid the body of superfluous vitamins, most users are doing no more than creating "expensive urine."

Australians' willingness to part with large sums of money for supplements that are unlikely to be doing them any good has puzzled Professor John Dwyer, the clinical program director for medicine and oncology at Sydney's Prince of Wales Hospital. He suspects some people are simply hankering for a little "magic and mysticism," while others think they can compensate for a destructive lifestyle by swallowing megadoses of supplements. Australians are crying out for advice about disease prevention, he says, but the people they should be getting it from - GPs - are being forced by the system into practicing "turnstile medicine": they don't have time to tailor individual programs for their patients, who instead are "listening to misleading advertisements and drifting off into unscientific hands."

Supporters of non-prescription medicine resent this characterization. "I don't think the Australian public is stupid," said Complementary Healthcare Council of Australia president Ian Brighthope, a GP who says he writes only about four prescriptions a year. "Consumers take natural health products for one reason: because they work. People feel better, and they get better."

Dwyer says it's wrong that pharmacists - university-educated people whom the public often rely on for sound advice - should be retailers of non-prescription supplements. Sydney pharmacists visited by Time looked embarrassed when asked about the efficacy of vitamin tablets. One declined to be interviewed; another mumbled that "it was a very complicated issue" before suddenly feeling compelled to attend personally to every customer in his shop. A third, Sam Dalzell, was more forthcoming: "Some people believe strongly that the pills are working for them," he says, "so that alone can make them worthwhile." Supplements, he estimates, account for about 10% of his pharmacy's business.

The placebo effect and strong consumer demand are central to the Pharmacy Guild of Australia's position on supplements. "If you ask me my personal opinion [about whether these products do any good], it would differ a lot from what those people feel, but the products are there, aren't they?" says national president John Bronger. "On one hand, we're defending the traditional medicines of indigenous communities and Asian culture, and yet we can be quite ruthless in criticizing our own complementary medicines."

That criticism is justified, says Prof. Dwyer, who argues that the downside to dabbling in supplements may not be confined to wasting your money. Some users become preoccupied with "cleansing their liver" or "boosting their immune system," he says. But people need to understand "the essential harmony of the body's systems working together . . . you don't want to go distorting that harmony by flogging one aspect of it." Those people who are forced by Pan's troubles to go without their usual supplements may want to ask themselves a question during their period of deprivation: Do I feel any different?

- With reporting by Elizabeth Feizkhah/Sydney